Individual provider Active NPI

Maribel Bacalan, PT, DPT

  • Physical Therapist
  • Merrillville, IN
National Provider Identifier
1619444148
Registry record updated Feb 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
05012793A Issued in IN
Practice address
521 E 86TH Ave Ste J
Merrillville, IN 46410-6236
Phone
(219) 736-2801
NPI assigned
Nov 2, 2018
Last updated
Feb 4, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU
Physical Therapist 225100000X 05012793A IN Primary

Addresses

Primary practice location

521 E 86TH Ave Ste J
Merrillville, IN 46410-6236

Mailing address

521 E 86TH Ave Ste J
Merrillville, IN 46410-6236
Phone (219) 736-2801

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190308001101 IN Practitioner - Physical Therapist in Private Practice 4789923723 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Creative Health Care Management LLC Physical Therapist CurrentSince Mar 1, 2021 Accepting new patients
Creative Health Care Management LLC Physical Therapist CurrentSince Mar 1, 2021 Accepting new patients
Integrated Therapy Practice Physical Therapist Past Accepting new patients

Locations

300 E Washington Blvd
Fort Wayne, IN 46802
Phone (260) 422-5511

3630 Hickory Rd
Mishawaka, IN 46545
Phone (574) 252-7225

10 S 9th St
Ste 4
Noblesville, IN 46060

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612396800000",
    "number": "1619444148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 E 86TH AVE STE J",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106236",
            "telephone_number": "219-736-2801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 E 86TH AVE STE J",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106236",
            "telephone_number": "219-736-2801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACALAN",
        "first_name": "MARIBEL",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-02",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05012793A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merrillville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.